December 14, 2005

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Publication Date: Wednesday, December 14, 2005

Health & Fitness: Sounding the alarm about diabetes

By John Flood

Special to the Almanac

Dr. Walter Bortz can still recall the day 70 years ago when he visited his grandfather. The old man was seated on an over-stuffed chair. His leg, propped up on a stool, was chewed up with gangrene.

He remembers the horrible odor and the suffering, made worse by his grandfather's refusal to have his leg amputated.

His grandfather died soon thereafter. Diabetes killed him.

Today, Dr. Bortz of Portola Valley is a leading authority on diabetes and aging. And now, he's on a mission. He travels the nation meeting politicians, business leaders and educators, all in an effort to raise awareness about the causes and prevention of diabetes.

And his latest book, "Diabetes Danger: What 200 Million Americans At Risk Need to Know," was released this fall, with all the latest information about the disease and how to prevent it.

"Fifty years ago, diabetes was a blip on the radar. It wasn't a big deal. Now it is," Dr. Bortz says. "A Yale University study says that diabetes will be the leading cause of death in 20 years."

If Dr. Bortz comes across like an evangelist on a crusade, the data about diabetes might explain why he's so concerned.

According to his book, "Diabetes Danger," about 20 million Americans are currently diagnosed with diabetes. One million new cases are diagnosed every year. By 2030, it is estimated that 30 million Americans will have the disease.

Dr. Bortz also notes that although a 2004 estimate provided by the federal Department of Health and Human Services suggests that 41 million people within the age range of 40 to 74 are pre-diabetic, "the total number is probably around 50 million."

Research has shown that several conditions exist in people for years before diabetes manifests itself. These pre-diabetic conditions can include high blood fat levels, high blood pressure, high blood sugar, and being overweight.

If Americans don't make basic lifestyle changes, Dr. Bortz asserts, there could be wide-ranging catastrophic results: the health care system will be overwhelmed; the financial consequences will imperil Medicare; the cost of health insurance premiums will soar; and pension plans of American industry will go bankrupt. And the human cost is suffering and eventual death. All of it, preventable.

Dr. Bortz states in his book that a diabetic requires $11,000 in additional medical expenses every year. With 20 million diabetics in America today, that represents an additional cost of $220 billion in annual medical expenses.

And beyond the people already diagnosed, Dr. Bortz is also concerned about the millions of Americans who are currently living with a pre-diabetes condition that they are unaware of, fueled by too many calories and a sedentary lifestyle.

In sounding the alarm, Dr. Bortz presents a grim description of the debilitating symptoms of a diabetic. They can suffer from a range of problems including blindness, gangrenous limbs requiring foot and leg amputations, kidney failure, and a high risk of stroke and heart attack.
Two types

Diabetes has two guises. Type 1 is commonly found in young people. Called "juvenile diabetes," it is typically caused by a lack of insulin production in the pancreas.

Insulin is essential in the complex processing of sugar and glucose by the body's cells. And the Type 1 diabetic lacks this essential function.

The symptoms of Type 1 are aggressive and come on suddenly. Within four weeks of onset, it is usually diagnosed.

Until recently, Type 2 diabetes, also called "adult onset," typically afflicted older adults in their 70s, 80s and beyond. It was considered a disease of the aging, and a "seeming minor emergency," Dr. Bortz says.

Unlike Type 1 diabetes, where there are insufficient insulin levels, Type 2 diabetes is caused by the body's tissues resisting insulin.

Today, Type 2 is the most common form of diabetes, representing 98 percent of diagnosed cases. The startling increase in what was once a disease commonly found in older people has reached epidemic proportions across all age groups and ethnicities.
Obesity and inactivity

The cause of Type 2 diabetes, according to Dr. Bortz, is directly linked to obesity and inactivity -- what he calls "interdependent co-conspirators."

The obese person lives with an altered metabolism because of the over-abundance of fat in the blood stream, the liver, the pancreas and the muscles. The presence of fat impedes glucose utilization, which, in turn, causes higher blood sugar, he says.

The pancreas, sensing the presence of sugar, creates more insulin. This sets in motion a procession of chemical reactions in the body, all trying to adapt to an unnatural and dangerous overabundance of fat.
Behavioral intervention

Dr. Bortz's prescription isn't found in a pill. The health care system is poorly equipped to help you, he says.

His emphasis is on prevention and behavioral change. "Take a walk," says Dr. Bortz. "Move."

One of the best-known examples of someone who changed his life to meet the challenges of Type 2, obesity-induced diabetes is Gov. Mike Huckabee of Arkansas, who was diagnosed in 2003.

He weighed more than 300 pounds, ate fast food, and he never exercised. It's wasn't until his physician told him that he was facing the last decade of his life that Gov. Huckabee decided to change.

Since then, he has dropped more than 100 pounds by exercising daily and eating healthful foods. Today, he runs marathons.

Exercise, Dr. Bortz says, has been shown to have "a strong positive effect on the way muscle cells use insulin."

Dr. Bortz has concluded that our early ancestors were thinner and healthier because they were active hunter-gathers. They had to work hard to put food on the table. And the gene pool we inherit from them suggests that our bodies are pre-disposed to responding well to exercise and eating well in moderation.

The modern world conspires to make us fat, he says. And the preponderance of junk food and labor-saving devices are a dangerous cocktail that lead to a plethora of ailments including diabetes, hypertension and stroke.

"You need to take control," he says. And that means making better food choices and exercising regularly.

He just doesn't walk. Dr. Bortz, 75, runs a marathon every year. And he keeps in shape by running three days each week.
No easy solution

Solving the diabetes epidemic will not occur with the magic bullet, according to Dr. Bortz. Instead, it requires the combined efforts of individuals, parents, educators, medical practitioners, government and industry.

"Knowledge and education is a good first-line defense," he says.

He endorses a set of financial incentives that will motivate individuals, doctors and businesses to take responsibility.

Gov. Huckabee launched a far-reaching, comprehensive program in his state called "Healthy Arkansas -- For a Better State of Health." The program involves government employees, health insurance providers, the media and schools.

State employees are encouraged to take a 30-minute exercise break each day. If certain criteria are met, employees receive a $250 rebate on health insurance.

Employers have already seen a 20 to 50 percent reduction in health care costs. School programs encourage nutrition and physical activities. Media campaigns encourage competition between towns, with awards given to the "The Healthiest."

Dr. Bortz believes that even the coordinated efforts of education programs, financial incentives, and government programs won't be enough to stop the diabetes epidemic.

It comes down to willpower.

If each person takes action through personal responsibility, then solving the diabetes epidemic is possible, he says.

Facts about diabetes
** 1 million new cases of diabetes are diagnosed in the U.S. every year.
** It is the fifth leading cause of death in the U.S.
** There are 20 million cases in the U.S. today; the figure is projected to rise to 30 million by 2030.
** It is the leading cause of blindness, a major cause of heart attack and stroke, and a leading cause of kidney failure in the U.S.
** There are 1 billion overweight people in the world.
** Globally, there are 171 million people with diabetes; the figure is projected to rise to 366 million by 2030.
Source: "Diabetes Danger," Dr. Walter M. Bortz

Symptoms of diabetes
** Fatigue
** Extreme thirst
** Frequent urination
** Unexplained weight loss
** Blurred vision
** Non-healing wounds
Source: "Diabetes Danger," Dr. Walter M. Bortz

Warning signs: conditions of 'pre-diabetes'

The following are considered "pre-conditions" of diabetes:
** A waist size greater than 40 inches in men and 35 inches in women.
** Blood triglycerides greater than or equal to 150 mg/dL, after fasting.
** HDL cholesterol less than 40 mg/dL in men and 50 in women.
** Blood pressure greater than or equal to 130/85.
** Glucose greater than or equal to 110 mg/dL, after fasting.
Source: American Heart Association

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